A Bayesian hierarchical assessment of gastric emptying with the linear, power exponential and modified power exponential models.

BACKGROUND: Many studies assessed gastric retention over time utilizing different models, mostly with scintigraphic measures at varied endpoints from limited number of normal volunteers. With a standardized 4-h gastric emptying (GE) protocol, we compared model fit by the linear, power exponential (PE), and modified power exponential (MPE) models to contrast differences in GE among different groups based on clinical diagnosis and gender. METHODS: We retrospectively collected 320 patient records with four consecutive hourly scintigraphic measures of percent intragastric residual at the Kansas University Medical Center. We obtained parameter estimates with the Bayesian hierarchical models using informative priors from previous research. KEY RESULTS: The PE or MPE model captured the time dependent GE rate better than the linear model. The estimated GE rates more than doubled for those without gastroparesis compared to patients diagnosed with gastroparesis. Males tended to empty gastric content faster but were not significantly different from females at the 5% level. CONCLUSIONS & INFERENCES: The point estimates and 95% credible interval for GE rates obtained with the PE and MPE models may provide an alternative diagnostic tool for clinicians since it utilizes gastric emptying scintigraphy measures at multiple endpoints which may be sensitive to different aspects of the disease. No agreement in lag phases was obtained by the three models based on respective definitions from previous researches, but similar results would be obtained with the PE and MPE models if both defined lag phase by back projecting the regression lines to the same gastric retention level.

[Cost-effectiveness of atorvastatin for the prevention of coronary disease. An analysis of the ASCOT study]. / Kosteneffektivität von Atorvastatin zur Prävention der koronaren Herzkrankheit. Eine Analyse der ASCOT Studie.

BACKGROUND: Increasing health service expenditure, on the one hand, and the politically declared objective of stability of statutory contributions and restriction of public funds, on the other hand, have been central points in the political and social discussion for several years. PATIENTS AND METHODS: Cost-effectiveness of Atorvastatin in primary prevention was analysed by applying the results of the Anglo Scandinavian Cardiac Outcomes Trial (ASCOT study) to the German health system. Costs and effectiveness were subject to an extensive sensitivity analysis. RESULTS: The cost-effectiveness of Atorvastatin treatment in Germany is approximately 10,102 Euro (95% CI: 9109; 12,881) per life-year gained. Taking 2004 price reductions into consideration, these values are reduced to 7311 Euro [95% CI: 5197; 10,091) per life-year gained. The robustness of this result was substantiated through extensive sensitivity analyses. CONCLUSION: The administration of the lipid lowering compound Atorvastatin in hypertensive patients with additional coronary heart disease risk factors in Germany is cost-effective.

The role of losartan in cost-effective hypertension control.

Despite recent guidelines emphasising the need for aggressive treatment in patients with elevated blood pressure, the control of hypertension in Europe and the USA is poor, imposing a considerable burden in terms of patient morbidity and mortality, and associated healthcare costs. A major factor contributing to the suboptimal control of hypertension is the failure of patients to adhere to their prescribed therapy. Drug side-effects are an important cause of non-compliance and prescribing a well-tolerated agent that promotes good compliance is therefore the key to the cost-effective management of hypertension. Several studies have demonstrated that patients are more likely to remain on therapy with the angiotensin II antagonist losartan than other antihypertensives. Although the acquisition costs of new antihypertensives such as losartan are greater than for older drugs, such costs represent only a small proportion of the total cost of prescribing antihypertensive therapy. When accessory costs are also considered, the total cost of care with newer antihypertensives is comparable with those for diuretics. The costs involved if therapy has to be switched due to unacceptable side-effects also need to be taken into account when assessing relative cost effectiveness. Furthermore, savings may accrue from the non-haemodynamic benefits of losartan, such as improved cognitive function and renal protection. Further studies will increase awareness of the true cost effectiveness of antihypertensive drugs.

Changes in antihypertensive therapy--the role of adverse effects and compliance.

In a German multicentre study (1603 patients, 320 private practices), adverse effects and patient compliance during antihypertensive therapy were investigated using standardized questionnaires for both patient and physician. Patients with a change in antihypertensive therapy during the last six months were included in this study. The single most important reason for the change in therapy was inadequate blood pressure control (48.4%), followed by adverse effects (30.1%), patient dissatisfaction (20.0%), non-compliance (16.8%) and cost (4.9%). The most frequent adverse effects noted by the doctors were cough (51.9%), oedema (36.9%), flush (36.6) and dizziness (27.8%). In comparing the answers of the physicians and patients, it becomes obvious that compliance may be overestimated by the doctors (good: 41.7%; medium: 57.3%; bad: 1.0%), since only 32.3% of the patients stated that they never missed a dose, 54.8% were occasionally non-compliant and 12.9% admitted missing a dose frequently. The predominant reasons for non-compliance (assessed by the patients) were forgetfulness (40.4%), followed by adverse effects (9.6%) and irregular lifestyle (6.5%). Thus, lack of effectiveness and adverse effects/patient dissatisfaction/non-compliance contributed roughly equally to the decision to change therapy. In addition, forgetfulness was shown to be an important contributor to suboptimal compliance. Lastly, physicians may still underestimate the extent of non-compliance.

Assessment of beta-blocking activity of low-dose bupranolol.

In the present study an investigation was made on the pharmacodynamic effect of the beta-blocking agent bupranolol in the low-dose range. Bupranolol is usually given in doses of 100 mg twice daily in the treatment of hypertension, however the dose range between 20 and 100 mg was studied using graded isoproterenol injections in healthy volunteers. A significant beta-1-blocking activity was observed for the 20 mg dose already. This effect was reduced after a treatment of 10 days. The effect increased with the higher doses, there might be a linear correlation between the logarithm of the dose and the reduction of the tachycardia after the isoproterenol injections in the low-dose range. It was concluded that using the safe and sensitive isoproterenol injection method, the clinical effect of very low doses of bupranolol may be demonstrated. The low dose might be useful to reduce the reflex tachycardia seen in the treatment of hypertension with vasodilating drugs.